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Section 1: Symptom Frequency Score

Input the frequency of each of the following symptoms.

0-None, 1-Mild, 2-Moderate, 3-Severe

1. Unexplained fever, sweats, chills, or flushing

2. Unexplained weight change; loss or gain

3. Fatigue, tiredness

4. Unexplained hair loss

5. Swollen glands

6. Sore throat

7. Testicular or pelvic pain

8. Unexplained menstrual irregularity

9. Unexplained breast milk production; breast pain

10. Irritable bladder or bladder dysfunction

11. Sexual dysfunction or loss of libido

12. Upset stomach

13. Change in bowel function (constipation or diarrhea)

14. Chest pain or rib soreness

15. Shortness of breath or cough

16. Heart palpitations, pulse skips, heart block

17. History of a heart murmur or valve prolapse

18. Joint pain or swelling

19. Stiffness of the neck or back

20. Muscle pain or cramps

21. Twitching of the face or other muscles

22. Headaches

23. Neck cracks or stiffness

24. Tingling, numbness, burning, or stabbing sensations

25. Facial paralysis (Bell's palsy)

26. Eye/vision: double, blurry

27. Ears/hearing: buzzing, ringing, ear pain

28. Increased motion sickness, vertigo

29. Light-headedness, poor balance, difficulty walking

30. Tremors

31. Confusion, difficulty thinking

32. Difficulty with concentration or reading

33. Forgetfulness, poor short-term memory

34. Disorientation: getting lost; going to wrong places

35. Difficulty with speech or writing

36. Mood swings, irritability, depression

37. Disturbed sleep: too much, too little, early awakening

38. Exaggerated symptoms of worse hangover from alcohol

Section 2: Most Common Lyme Symptoms Score

If you rated a 3 for each of the following symptoms in section 1, give yourself 5 points for each one you did.

39. Fatigue

40. Forgetfulness, poor short-term memory

41. Joint pain or swelling

42. Tingling, numbness, burning, or stabbing sensations

43. Disturbed sleep: too much, too little, early awakening

Section 3: Lyme Incidence Score

Now for each of the following statements that is true, give yourself the point value found at the end of the statement. If a statement is false, click the box to generate a "0".

44. You have had a tick bite with no rash or flulike symptoms. (3 points)

45. You have had a tick bite, an erythema migrans, or an undefined rash, followed by flulike symptoms. (5 points)

46. You live in what is considered a Lyme-endemic area. (2 points)

47. You have a family member who has been diagnosed with Lyme and/or other tick-borne infections. (1 points)

48. You experience migratory muscle pain. (4 points)

49. You experience migratory joint pain. (4 points)

50. You experience tingling/burning/numbness that migrates and/or comes and goes. (4 points)

51. You have received a prior diagnosis of chronic fatigue syndrome or fibromyalgia. (3 points)

52. You have received a prior diagnosis of a specific autoimmune disorder (lupus, MS, or rheumatoid arthritis) or of a nonspecific autoimmune disorder. (3 points)

53. You have had a positive Lyme test (IFA, ELISA, Western blot, PCR, and/or borrelia culture). (5 points)

Section 4: Overall Health Score

54. Thinking about your overall physical health, for how many of the past 30 days was your physical health not good?

55. Thinking about your overall mental health, for how many of the past 30 days was your mental health not good?

Scoring

Your total scores for each section are recorded below. Click "calculate" to add them together to achieve your final score.

Not all input boxes are filled. If no value, click the box to generate a "0".

Calculate

Final Score: Under 21

If you scored under 21, you are not likely to have a tick-borne disorder.

Final Score: Between 21 and 45

If you scored between 21 and 45, you possibly have a tick-borne disorder and should see a health-care provider for further evaluation.

Final Score: 46 or more

If you scored 46 or more, you have a high probability of a tick-borne disorder and should see a health-care provider for further evaluation.

Take Dr. Horowitz's Lyme-MSIDS Questionnaire Online - Tired of Lyme

Dr. Richard Horowitz, M.D.'s Lyme-MSIDS Questionnaire

Tired of Lyme